SCAR REMOVAL SURGERY
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SCAR REVISION - SCARS REMOVAL SURGERY
Every normal skin healing occurs by replacing damaged tissue with new connective tissue – cicatrisation (i.e. scar creation). During normal skin healing a fine linear scar is created which is hard to notice.
In order for scar to be least noticeable, incision needs to be planned well preoperatively. Surgical incision is planned in such a way that the final scar lies parallel or just besides relaxing skin tension lines that match wrinkle lines.
If there is disturbance in healing of the wound so called abnormal scars are created which manifest as 1) wide spread, 2) hypertrophic and 3) keloid.
Wide spread scars were described for the first time in 1987 by Rudolph and they are characterized by having the exactly same order of collagen fibers as normal scars. Clinically typical wide spread scar is flat surfaced, wide and often dented.
Hypertrophic scars represent an abnormal growth of scar tissue that does not spread into the skin, which is not affected by the original wound. With hypertrophic scars period of maturation id between 18 and 24 months.
Keloid scars are abnormal scar growth that spreads to skin not affected by original wound.
ABNORMAL SCAR TREATMENT
Before scar treatment begins a following must be established: diagnosis, scar localization, orientation, length, width, pigmentation, contour irregularity, distortion of anatomical marks and scar age. A clinical differential diagnosis between keloid, hypertrophic or wide spread scar must be set, and only then we can begin scar treatment. Abnormal scar treatment depends on surgeon's assessment. Abnormal scar treatment can be: nonsurgical, surgical and combined.
A) NONSURGICAL SCAR TREATMENT
Abnormal scar treatment with Contractubex. It exhibits antiproliferative, anti-inflammatory softening effect on proliferative scar tissue. It is applied by gently massaging into skin a couple of times a day until all of the gel is absorbed.
Compression treatment. It is started early in the maturation phase by compression with a special elastic suite or corset. Compression needs to be constant 24 hours a day for the next 6 to 12 months.
Silicone materials. They can be shaped like a tile (Cica Care) or in a gel form (Dermatix) and they have positive results in hypertrophic scar treatment with treatment that lasts 24 hours a day for 6 to 12 months.
Retinoic acid. It inhibits collagen creation and if used locally two times a day for the duration of 1 year, good results are obtained.
Other nonsurgical treatments. Intrascar corticosterioids injection (Kenalog 10) or interferon, radiation treatment, electrophoresis, hydrotreatment, etc. are used rarely nowadays.
B) SURGICAL CARE OF ABNORMAL SCARS
Meticulous surgical technique is essential for achieving a good scar. Subdermal tissue is sutured in layers by individual stitches, while the skin is sutured with extension intradermal stitch using fine monofilament suture with atraumatic needle. Stitches on the face are removed after 5 to 7 days while on the other parts of the body they are removed after 12 to 14 days.
Skin expansion. Expanders are shaped like a balloon and are made from silicone elastomers in different shapes and sizes. They are connected via thin hose with connector through which saline solution is injected in defined time intervals until desired inflation is achieved, and with that a controlled skin surface increase. Excess skin gained by expansion is used for defect reconstruction that secondary occurs on the place of abnormal scar tissue excision.
Laser excision of abnormal scar. This method has gained earlier great publicity, however today's reports give mixed success, not so good as expected.
Dermabrasion. This method has no effect on wide spread scars. Effect can be achieved through dermabrasion only on uneven and raised scars such as acne scars on the face.
Every normal skin healing occurs by replacing damaged tissue with new connective tissue – cicatrisation (i.e. scar creation). During normal skin healing a fine linear scar is created which is hard to notice.
In order for scar to be least noticeable, incision needs to be planned well preoperatively. Surgical incision is planned in such a way that the final scar lies parallel or just besides relaxing skin tension lines that match wrinkle lines.
If there is disturbance in healing of the wound so called abnormal scars are created which manifest as 1) wide spread, 2) hypertrophic and 3) keloid.
Wide spread scars were described for the first time in 1987 by Rudolph and they are characterized by having the exactly same order of collagen fibers as normal scars. Clinically typical wide spread scar is flat surfaced, wide and often dented.
Hypertrophic scars represent an abnormal growth of scar tissue that does not spread into the skin, which is not affected by the original wound. With hypertrophic scars period of maturation id between 18 and 24 months.
Keloid scars are abnormal scar growth that spreads to skin not affected by original wound.
ABNORMAL SCAR TREATMENT
Before scar treatment begins a following must be established: diagnosis, scar localization, orientation, length, width, pigmentation, contour irregularity, distortion of anatomical marks and scar age. A clinical differential diagnosis between keloid, hypertrophic or wide spread scar must be set, and only then we can begin scar treatment. Abnormal scar treatment depends on surgeon's assessment. Abnormal scar treatment can be: nonsurgical, surgical and combined.
A) NONSURGICAL SCAR TREATMENT
Abnormal scar treatment with Contractubex. It exhibits antiproliferative, anti-inflammatory softening effect on proliferative scar tissue. It is applied by gently massaging into skin a couple of times a day until all of the gel is absorbed.
Compression treatment. It is started early in the maturation phase by compression with a special elastic suite or corset. Compression needs to be constant 24 hours a day for the next 6 to 12 months.
Silicone materials. They can be shaped like a tile (Cica Care) or in a gel form (Dermatix) and they have positive results in hypertrophic scar treatment with treatment that lasts 24 hours a day for 6 to 12 months.
Retinoic acid. It inhibits collagen creation and if used locally two times a day for the duration of 1 year, good results are obtained.
Other nonsurgical treatments. Intrascar corticosterioids injection (Kenalog 10) or interferon, radiation treatment, electrophoresis, hydrotreatment, etc. are used rarely nowadays.
B) SURGICAL CARE OF ABNORMAL SCARS
Meticulous surgical technique is essential for achieving a good scar. Subdermal tissue is sutured in layers by individual stitches, while the skin is sutured with extension intradermal stitch using fine monofilament suture with atraumatic needle. Stitches on the face are removed after 5 to 7 days while on the other parts of the body they are removed after 12 to 14 days.
Skin expansion. Expanders are shaped like a balloon and are made from silicone elastomers in different shapes and sizes. They are connected via thin hose with connector through which saline solution is injected in defined time intervals until desired inflation is achieved, and with that a controlled skin surface increase. Excess skin gained by expansion is used for defect reconstruction that secondary occurs on the place of abnormal scar tissue excision.
Laser excision of abnormal scar. This method has gained earlier great publicity, however today's reports give mixed success, not so good as expected.
Dermabrasion. This method has no effect on wide spread scars. Effect can be achieved through dermabrasion only on uneven and raised scars such as acne scars on the face.